Provider Demographics
NPI:1700064912
Name:RAUSCH, RICHARD WAYNE (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYNE
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5214
Mailing Address - Country:US
Mailing Address - Phone:312-944-1876
Mailing Address - Fax:312-944-8959
Practice Address - Street 1:1850 N MOHAWK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5214
Practice Address - Country:US
Practice Address - Phone:312-944-1876
Practice Address - Fax:312-944-8959
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist